Dr. Lin's head was so big that he snatched the medical records from the nurse and complained, "You didn't say anything!"
"Did Dr. Zhang not tell you about the shift, Dr. Lin? Before we asked Dr. Zhang if this patient had any family members, she said she would ask, but she didn't tell us what the situation was." The nurse replied, not going to accept this pot.
Zhu Huicang raised his glasses, first recognized Xie Wanying's facial features, and recalled the meeting more than three years ago: Is it the girl who let Cao Yong see the lost soul?
"Is she studying in our hospital now?" Zhu Huicang asked his old classmate Ren Chongda.
"I'm going to the neurosurgery department for a traineeship, isn't that following Huang Zhilei?" Ren Chongda said.
"Oh." Zhu Huicang thought: Could someone go crazy with joy, because the younger sister came to his department as a trainee.
This Dr. Lin turned over the electrocardiogram that Dad Liu had done before: "This, this—"
Zhu Huicang followed his head closely and looked at it, then glanced at Dr. Lin: "The patient you saw?"
"No, it's not me!" Dr. Lin tried his best to deny, "She didn't say that his electrocardiogram had changed, what she said was that the electrocardiogram looked fine, and the three blood tests for myocardial infarction were normal."
Such a big thing happened, he can't bear this pot!
"Is this nothing? Isn't the ST segment depressed?" Zhu Huicang pointed out the problem at once, "Isn't this a typical sign of myocardial ischemia?"
Doctor Lin of course saw the same, otherwise why would he deny it desperately: "Yes, yes, it is myocardial ischemia."
"It's not just myocardial ischemia, right? The patient's main complaint is that the chest pain seems to have been vague since the morning, and it was at least a few hours before being admitted to the hospital. It must be acs. If it is acs, it must be vigilant. Go The guardianship is at least eight hours. How long has it been since he entered the emergency room of our hospital?" Zhu Huicang asked, looking at the watch on his hand to calculate the time.
acs refers to acute coronary syndrome.
First of all, a normal myocardial enzyme test does not mean that there is no myocardial infarction.
The standard diagnosis of myocardial infarction is not based solely on myocardial enzyme examination, but on electrocardiogram or myocardial enzymes or clinical symptoms, two of which can be diagnosed.
Secondly, pseudo-normal performance may also occur on the ECG.
For example, some patients with myocardial infarction may just happen to be in the hyperacute period when the doctor does the ECG to the patient. At this time, the ST-T abnormality of the patient in the acute myocardial injury period reaches the fully developed period, and the ECG just returns to the normal state. It is said that the normal at this time is a pseudo-normal.
Therefore, the electrocardiogram made during this period is very easy to cause the doctor to misjudge the patient. Father Liu may be such a typical case.
Experienced hospitals must have guidance and requirements for clinicians in the diagnosis and treatment of myocardial infarction.
For example, the National Association stipulates that if the first ECG examination is generally normal, Liu's father complained that it was abnormal and suspected that it was ACS. As Zhu Huicang said, he needed to be monitored for more than eight hours.
Eight hours of ECG monitoring does not mean that the doctor can ignore the patient's connection to the instrument, and such monitoring is meaningless. What is needed is that the doctor comes back from time to time to see if the patient's electrocardiogram has developed or changed. The subtle changes in the patient's condition require the doctor's sufficient vigilance and sense of responsibility to catch them. If it is a doctor with a strong sense of responsibility, he will even perform an ECG on the patient every once in a while. Because and Xie Wanying began to argue with Dr. Jiang, ECG monitoring belongs to analog leads and there is no ECG machine standard.
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